Behavioral Healthcare Critical to Arizona’s “Healthiest State” Mission / by Joe Furia

Here at AzHHA, our No. 1 focus is on making Arizona the Healthiest State in the Nation. While we’ve made significant strides, serious challenges remain. Among them is the need to find better and more sustainable ways of preventing, treating and managing behavioral healthcare needs of Arizonans.

For decades, behavioral healthcare issues were thought of as “someone else’s problem” – confined to a select few in our society. Many of these patients’ issues were addressed by locking them away in state institutions – far from the rest of us, out of sight and mind. Other patients suffered in silence. 

Our awareness of their circumstances has been elevated in part by the media, but perhaps even more by policy decisions in the 1960s to deinstitutionalize and treat many such patients in the community setting. Today, people with behavioral healthcare needs live and work among the general population. 

What became clearer over time was that behavioral health issues were more common and closer to home than many of us had ever realized. We tried hard to avoid this conclusion for many years with a social stigma against such problems. Remember when it was almost disqualifying for a political candidate to even admit to seeing a mental health counselor?

To a great extent, we have progressed in our understanding of the causes of behavioral healthcare needs and can provide appropriate therapy and medication to support patients. The Behavioral Health hospitals in AzHHA do us proud with their efforts to advance the understanding of those with behavioral healthcare needs and deliver high-quality, evidence based clinical interventions to help patients. 

We’ve seen important policy shifts, too, like payment parity for behavioral health in health insurance coverage. Further, integrating care of the mind and body simultaneously is an important element of a major effort by Arizona’s AHCCCS program to improve how WE support both the mental health and physical needs of people in this program. 

Still, in many ways we remain far behind where we need to be to support patients with behavioral healthcare needs. That’s due in large part to the stigma of mental disease that still exists . . . but policy problems are also apparent: few believe coverage parity has been achieved in practice. Demand for service continues to rise. Old laws and conceptions continue to get in the way of doing better.

One example of the latter is an outdated and burdensome Institutions for Mental Diseases (IMD) exclusion in Medicaid. Since Congress established Medicaid in 1965, the program’s IMD exclusion has prevented Medicaid beneficiaries (ages 21-64) from accessing short-term, acute care in psychiatric hospitals. Patients with serious behavioral healthcare needs often require a longer inpatient stay. However, because of Medicaid’s IMD exclusion, these medically necessary inpatient stays are unavailable to low-income Arizonans. We can do better than this.

Click on the image below for more on IMD.

The IMD exclusion stands as a major obstacle to adequately addressing the behavioral health service crisis. A national effort is underway to remove this exclusion with respect to substance abuse disorder treatment and a provision is included in the opioid legislation being considered by Congress, but even these legislative efforts currently in Congress fall short of what Arizona needs to remove this major barrier to care.

Another major issue is the chronic underfunding of behavioral health, both by public programs and private payors. Just like historic gaps in providing coverage for mental health, there is a cultural and historic gap in calculating the amounts that hospitals and other providers are paid to take care of patients. That these individuals are among the most vulnerable of our society, and at risk of causing harm to them self and others because of it, only makes the problem worse.

This October 10th is World Mental Health Awareness Day, and October 7 to 13 is National Mental Health Awareness Week. Let’s use this opportunity to turn rhetoric into action – to not just acknowledge the need to do better, but to actually commit ourselves to solving these problems. After all, behavioral healthcare is not “someone else’s problem.” Directly or indirectly, it affects all of us – and the time to do something is now.